Laserfiche WebLink
Please Cri urNne_ IFmm&n Innodw erre r»..,u.r,rs,,. ..n .. <br />__ _ __,.._..___..�w.....................„,. DESIGNATED FACILITY TO GENERATOR STATE (IF REQUIRED) <br />UNIFOR HAZARDOUS- 1. GeneratorlDNumber2.Pagelof 3.EmergerwYResponsa Phone Manliest Tracking NumberVxw 'LOw•uwa <br />WASTE MANIFEST C A L 0 0 0 2 6 9 3 7 5 1 00� 44.9300 " 0 09894956 JJ K <br />r , <br />ASeGaerteratoes Name anti Mail'atg Address Generators Site Address(it different than malhg address) <br />PICKNPULL#O <br />3527 CLARK DR. <br />STOCKTON Cul 95205 <br />Generaloes Phone: 209 462-1927 <br />8. Trenapwtef 1 Eipany Name U.S. EPAID Number <br />ASBURY DINIRONIVENTAL SERMCES CA D 0 2 8 2 7 7 0 3 6 <br />7. Transporter 2 Company Name U. S. EPA ID Number <br />B. Designated Mary Name and Sita Address U.S. EPA IO Number J <br />D WENNO/KERDOON='•—• <br />N. ALAlaEDA STREET <br />CONPTON CA S.2? C A T 0 0 00133 82 <br />Fall s Phone: I 0 0107-7 1 00 <br />ga, <br />0.U.S.00T Descrip8m Oncludrng ProperSNppkg Name, Hazard Class, D Number, <br />lo.Contaheto <br />11.Tow <br />12. Unit <br />HM <br />and Packing Group Of any)) <br />Quantity <br />Wtrygl. <br />13. Waste Codes <br />No. <br />Type <br />r— <br />1. <br />NON -RORA HAZARDOUS' WASTE, LIQUID (USED 011. M) ED OIL <br />D <br />YIITH SODIU1v1SILICATEI <br />D DA��/ <br />G <br />3. <br />4. <br />14. Spedal HaMllnp Instiuc0ore aMAddNaiwl Inlamadan <br />9NERGENOY CONTACT: CHENITREO 1-1200.424-M NAERG#981: 171' PROrILE 4981: 052612 USED OIL1f4TM OIL <br />WITH SOOIUNI SILICATE 1 PO# A110iNFM v APPROPRIATE PERSONAL P.ROTEOTIYE EQUIPMENT -- <br />15.-GENERATOR'SIOFFEROWS CER9IFICATN)N; I herebydedafe that Ore contents of this oon}gnmantare Nity and accurately described above by the propershippirg name, and we clas0ed, packaged, <br />marked and labeledrplacarded, and are In a9 msp" in proper condition for transport according to applicable IntemallaW and national governmental regidaaons. If export shirarwnl and I am the Primary <br />Exporter, I cetuy that the contents of this consignrnenlconform N the farms of the attached EPAAckwMedgment of Consent <br />I ceNy that the waste minim'vaton statement Identified N 40 CFR 282.27(x) Of l am a large quantity generator) or @) (ilf am a small quantity generator) Is bug. <br />Ge emtofd0earols Pdnlad?yped Name r Pfh S' N <br />Ute( tin( <br />—1 <br />16. Inlemadonal Shipments <br />1:1 WWI, U.S. ❑Export train U.S. PIA ofentryladb <br />Transporter signature (for exports Orly): Dale Iewrg U.S.: <br />w <br />IT TrenspmterAckwMedgmenluf Rec* of Materials - <br />11.43W1eNfyped Name _ Sig fig MIA Qa Y r <br />AA <br />�j <br />Iramponatzrim ame Signature Montle Day Year <br />19.Olmoponcy .. f.. <br />His. Discrepancy Indication Space ❑ Quantity, ❑1YP El Residue ❑Partial Re)xticn ❑Full Rejection <br />Manifest Reference Number, <br />IBb. Alternate Fadliy, (a GeneraloQ _ � U.S. EPAIDNumbu <br />U <br />LL <br />w <br />C <br />Fadlivs Phone: _ <br />180. Signature ofAhomale Fadlity(ar Generator)- Month Day Year <br />.. .. <br />w19. <br />Hazardous Waste Report Management Mmhod Codes Q.e.; codes for hazardous wesla,treatmenh disposal, and recycling systems) <br />p <br />1. 2. ,. 3 4. <br />20. Designated Faclity Ocmer or Operator. Certification offacelpl Wiazardoue maledafs'layered by rite manliest except as nded In Ilam Ise �.— <br />N <br />Pdnl ped ame Si9naNre/j. Maoist Day ear <br />' z 42- <br />_ <br />__ _ __,.._..___..�w.....................„,. DESIGNATED FACILITY TO GENERATOR STATE (IF REQUIRED) <br />